BACKGROUND AND AIMS:Fenestrated cholecystectomy (FC), in which the gallbladder is left open, has been used to reduce the risk of common bile duct (CBD) injury. FC significantly increases the risk of postcholecystectomy bile leak (PCBL). ERCP with CBD stent placement is an effective treatment for PCBL. We aim to compare the efficacy of various stent types in treating bile leak after FC. METHODS:This retrospective multicenter cohort study included patients who underwent ERCP with biliary stent placement for the management of bile leak after FC. Data were collected, including stent type, size, stent position relative to cystic duct (CD) insertion, and outcome. The primary end point was defined as PCBL resolution on initial follow-up ERCP. RESULTS:One hundred forty-five patients were included. The most common stent length was 7 cm (100 of 145, 69%). The median time to initial follow-up ERCP showing PCBL resolution was 59 days (IQR, 48-71). There was no difference in PCBL healing based on stent position relative to the CD. PCBL resolution occurred in 106 of 113 patients (93.8%) with 10F stents, 12 of 13 (92.3%) with 7F stents, and 16 of 18 (88.9%) with fully covered self-expandable metal stents (FCSEMSs). Stent diameter had no impact on healing (P = .53). PCBL resolution occurred in 95 of 101 patients (94.1%) with straight plastic stents, 13 of 14 (92.9%) with double-pigtail plastic stents, 11 of 12 (91.7%) with single-pigtail plastic stents, and 16 of 18 (88.9%) with FCSEMSs. Stent type had no impact on PCBL resolution (P = .69). CONCLUSIONS:To our knowledge, this is the largest cohort studied in this population. There was no significant difference in PCBL healing irrespective of stent type, diameter, length, or positioning relative to the CD. This challenges the belief that a leak from a large fenestrated gallbladder opening requires a large-diameter stent or coverage of the CD. Plastic stents can be effectively used in bile leaks after FC and provide significant cost benefits.

We investigated the impact of racial/ethnic disparities in therapy initiation on colorectal cancer (CRC) mortality using Surveillance, Epidemiology, and End Results Program (SEER) database. Adults aged 18–84 years with CRC were identified. Cox models for 60-month all-cause and cancer-specific mortality were adjusted for demographics, stage, tumor site, income, and rural–urban residence. Therapy initiation was slower for Hispanics (HR 0.85) and non-Hispanic Black (NHB) patients (HR 0.80) compared with non-Hispanic Whites (p < 0.001). Each additional month of delay was associated with a 3

Introduction Underwater endoscopic mucosal resection (uEMR) technique has gained popularity for removal of large non-pedunculated colorectal polyps (LNPCPs) due to high en-bloc resection rates and lower recurrence rates. However, there is no information regarding outcomes of uEMR for giant colorectal polyps. Therefore, we aimed to evaluate the outcomes of uEMR for giant colorectal polyps across multiple centers in North America. Methods We conducted a multicenter retrospective study of adults with giant colorectal polyps undergoing uEMR between January 2019 and November 2025. Giant colorectal polyps were defined as LNPCPs ≥40 mm. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were severe adverse events (SAEs) and predictors of technical success, recurrence, and SAEs. Results A total of 137 polyps, with mean polyp size 47.6 mm were included. Majority of the lesions were located in right colon (61%, n = 83) with the most common histopathology being high-grade dysplasia (HGD) (31.4%, n = 43). Technical success was achieved in 90.5% ( n = 124) with en-bloc resection rate of 11.7% ( n = 16). Polyp fibrosis (OR: 0.08) and HGD (OR: 0.15) were independent predictors of inability to achieve technical success. Of 92 (67.1%) patients with follow-up, recurrent polyp was present in 8.7% ( n = 8). SAEs were noted in 9.5%, consisting of delayed bleeding (9.5%, n = 13), while no delayed perforation or post polypectomy syndrome was noted. Discussion Our study demonstrates that uEMR is technically feasible for the removal of giant colorectal polyps with an acceptable safety profile and recurrence rate.

INTRODUCTION:The American College of Gastroenterology assembled a multidisciplinary task force to evaluate the current state and future direction of artificial intelligence (AI) in gastroenterology, hepatology, and endoscopy leading to the development of consensus-based recommendations for responsible AI integration in clinical practice. METHODS:A total of 32 subject-matter experts and 12 industry partners, representing diverse practice settings and expertise, conducted subgroup literature reviews across 5 key areas (endoscopy, practice management clinical applications, training and education, inflammatory bowel disease and liver disease, ethics and equity). Draft statements were developed and rated on a 5-point Likert scale using a modified Delphi process. A consensus was set at ≥70% combined agreement. Nonconsensus items were revised and revoted electronically. RESULTS:A total of 43 statements, 40 (93%) reached consensus in round 1 and the remaining 3 achieved consensus after round 2. Evidence supports computer-aided detection improving adenoma detection rate and miss rate in controlled studies, with mixed real-world impact and insufficient long-term outcomes (e.g., interval colon cancer rate). Recommendations emphasize thorough validation and reduction of bias by heterogeneous Data sets. Outside endoscopy, ambient AI scribes, natural language processing (NLP)-enabled coding, workflow optimization, and previous authorization support show potential. Training recommendations endorse a structured AI curriculum while preserving independent procedural competence to avoid deskilling. In inflammatory bowel disease and hepatology, AI could help improve diagnostic accuracy, help predict risk of disease progression, and help guide therapy. Equity, governance, and reimbursement statements call for chain-of-custody data protections, specialty-society oversight, and payment models that reward quality and cost reduction. DISCUSSION:This consensus outlines how AI can augment rather than replace clinical expertise while promoting safety, transparency, interoperability, and equity. Priorities include pragmatic and prospective trials, multi-institutional data-sharing consortia, bias mitigation, and workforce training to enable trustworthy and clinically impactful AI adoption in gastroenterology, liver, and endoscopy care.